4 healthcare revenue cycle trends to watch in 2018

The revenue cycle process has continuously evolved over the years to keep pace with changes in the healthcare industry, and 2017 was no exception.

More technology solutions emerged to address value-based payment models, and the patient financial experience became even more important amid the rise in popularity of high-deductible health plans.

There is no doubt even more changes are in store for 2018. Here are four revenue cycle trends providers should keep an eye on next year.

1. Mega-mergers

The end of 2017 has been ripe with healthcare mega-merger news. CVS Health signed a definitive merger agreement to acquire Aetna for $69 billion, and Minnetonka, Minn.-based UnitedHealth Group's Optum unit will acquire DaVita Medical Group for approximately $4.9 billion. Those two transactions involve major payers, but several other deals involve giant health systems. Englewood, Colo.-based Catholic Health Initiatives and San Francisco-based Dignity Health signed a definitive agreement to merge into a single 139-hospital Catholic health system. Advocate Health Care, a 12-hospital system based in Downers Grove, Ill., and Aurora Health Care, a 15-hospital system based in Milwaukee, also announced plans to merge. And most recently, it was reported that St. Louis-based Ascension and Renton, Wash.-based Providence St. Joseph Health are exploring a potential merger that would create the nation's largest hospital operator.

This trend also expands beyond health systems and payers. In November, Advisory Board finalized a deal to sell the company's healthcare division to UnitedHealth Group's Optum arm for $1.3 billion.

With potential mergers like these, it begs the question of how is the revenue cycle affected when organizations combine.

Dan Ward, vice president of strategy at ZirMed, a revenue cycle solutions company, notes technology initiatives have dominated hospital revenue cycles in recent years, whether that means implementations of technology, some consolidation of technology, or potentially outsourcing of technologies.

When two entities decide to combine, they have both likely made great efforts to ensure their revenue cycles are supplemented with the right technology. Then they are forced to explore how the merger will affect their current revenue cycle systems.

"Whether it's overarching — one entity is on Cerner and the other is on Epic — or whether it's more specific in that they use different vendors for CDM [charge description master] management, it creates an interesting dilemma for the front-line staff as well as revenue cycle leadership, who have each separately and individually done a great deal to vet, customize, perfect and integrate their respective technologies," says Mr. Ward.

"And now in many ways hospitals [involved in mergers] are being asked to revisit that and start over. And that has profound implications on the revenue cycle not only immediately but in terms of future planning."

"With these mergers there's uncertainty on how that will play out and could potentially cause disruption with revenue cycle like what are we going to do about technology, what do we do about our operations, how are we going to standardize," she says.

2. Technology solutions

A more revenue cycle-centric trend Ms. Akrin deems worth watching is the increased use of solutions and technology geared toward risk adjustment tracking and coding.

She has observed vendors looking to offer providers solutions that track and manage new payment methodologies and models. For example, she says, vendors are making efforts to innovate how providers will track the receipt, disbursement and compliancy of bundled payments when different partner organizations and disparate technology platforms are involved.

So, the focus is on how to handle these more complex payment models rather than denial management or cash flow, Ms. Akrin says.

3. Patient financial experience and affordability

For years, patient financial experience has been a key issue for providers as patients take on greater financial responsibility for their care and increasingly seek price transparency. However, the need for providers to meet this price transparency demand will only become greater in 2018 because patients are educating themselves more about their healthcare choices, according to Kimberly Zeltsar, executive director of revenue cycle for Honolulu-based Kaiser Permanente, Hawaii Region.

A recent whitepaper from Accenture, "Show me the Money," reveals 60 percent of consumers said they proceeded with care with the provider of their choice in the last 12 months after learning their estimated out-of-pocket costs. Additionally, 46 percent of consumers said knowing their out-of-pocket price estimate is important to plan/budget for medical expenses.

Ms. Zeltsar says pricing transparency can help prevent delays in care and potentially bad debt for providers, making this issue one to watch next year.

Ms. Zeltsar also cited affordability as an issue to keep watching.

"We're hearing more about different providers and health systems tackling affordability, especially as more and more health plans are moving more responsibility to the patients' cost share. It's more important than ever to make care affordable, which also was the initial goal of the ACA," she says.

One way she sees providers tackling this is by improving automation through their patient management systems, providing more self-service capabilities and even robotic automation. "It's really taking some of that monotonous work and steps away and making it more automated so health systems in their revenue cycles can reduce costs," she says.

4. End-to-end revenue cycle vendors

In 2017, provider organizations have faced a myriad of financial challenges, including reduced reimbursement for certain patient populations, rising supplies and equipment costs, and rising bad debt expense. These issues are expected to continue in 2018, according to Gary Long, executive vice president and chief commercial officer at R1 RCM.

Given this expectation, he says more providers are eliminating vendors that only address one aspect of the revenue cycle.

Instead, next year "is poised for a transition to operating partners who can manage the entire process from end-to-end; automate repeatable routine processes for improved results and at a lower cost; and are able to positively impact the patient experience and satisfaction through revenue cycle touch points," he says.